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Key Concepts
Anthropology 393 – Cultural
Construction of HIV/AIDS
Josephine MacIntosh
April 5-8, 2005
Ethnocentrism &
Cultural Relativism
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Ethnocentrism: the practice of
judging another society by the values
and standards of one’s own society
Cultural relativism: the view that
cultural traditions must be understood
within the context of a particular
society’s responses to problems and
opportunities
Cultural Relativism
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The values of one culture should NOT be used
as standards to evaluate the behaviour of
persons from outside that culture
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A society’s custom and beliefs should by
described objectively
Modern approach
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Strive for objectivity and do not be too quick to
judge
Important Points
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The two main goals of anthropology are:
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To understand uniqueness and diversity
To discover fundamental similarities
The focus of cultural anthropology:
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Contemporary societies and cultures throughout
the world
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The goal of applied anthropology:
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To find practical solutions to cultural problems
Recall…
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Culture includes
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Physical aspects
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Objects
Actions
Mental aspects
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Thoughts
Beliefs
Values
Inventions
Rules
Language Transmits Culture
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Culture is a key concept in anthropology
Culture is the learned, shared way of life that
is transmitted from generation to generation
in a society
Humans learn through
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Experience (situational learning)
Observation (social learning)
Symbols (symbolic learning)
HIV Transmission Routes
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Blood transfusion is the most
efficient route for HIV infection
Sexual transmission is the most
common route of infection
75% of all HIV infections are sexually
transmitted
Epidemic Curves
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Classical epidemic curve is bell-shaped
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Steepness of slope is a measure of infectivity or
contagion
Length of the curve describes duration of epidemic
Highly infectious diseases (like measles):
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Short period of infectiousness (generally 2 weeks)
Relatively short duration (typically 6 months to a
year)
Epidemic Curves
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Not so with HIV/AIDS
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Marked by elongated curve
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Lengthy period of infectivity, enduring over
generations
Several distinct peaks
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As it moves through different populations
(MSMs, IDUs, etc)
Doing the Math
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Using this mathematical model and assuming:
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Exponential growth
A doubling time of 3 years
It would take:
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30 years for the prevalence of HIV to change from
0.001% to a detectable level of 1%
3 years to change from 10 to 20 percent
(Anderson & May, 1992:59)
Doing the Math
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Currently, the epidemic is spreading at twice
the initial predicted rate
Between 1999 & 2002, infection rates have:
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DOUBLED in East Asia & the Pacific
Increased 2 ½ times in North Africa & Middle East
Almost TRIPLED in Eastern Europe & Central Asia
Eastern Europe & Central Asia currently have
the fastest-growing epidemic in the world
Reponses to Infectious Disease
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Biologically appropriate interventions:
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Eliminate source of infection and/or
Eliminate contact with source and/or
Reduce infectivity and/or
Reduce susceptibility
Socially appropriate interventions:
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Limit social and economic disruption
Promote stability along prevention/care
continuum
(McGrath, 1991; 1992)
Deviance and Immorality
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Historically, STIs have been stigmatized
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Because of the connection with deviant or immoral
behaviour
Moral judgments are made based on
culpability
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Lifestyles at fault?  Pronounced ‘guilty’
Naïve partners of the guilty  pronounced
‘innocent’
Children of innocents  pronounced ‘defenseless
victims’
Deviance and Immorality
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Fear of moral judgment isolates
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Infected
Affected
‘At risk’
Can preclude health preserving behaviours
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Busza, 1999; Gilmore & Sommerville, 1994; Goldin, 1994
Probable result  accelerated epidemic
Social Construction of HIV
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Negative moral judgments
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Especially probable with HIV because stigma of
the illness is layered upon pre-existing stigmas
Does not encourage interventions which
are, at the same time, biologically and
socially appropriate
Seriously disrupts social systems
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Obstacle to prevention/care/treatment
Scope of the Problem
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HIV is spreading at twice the predicted rate
Limiting exposure to STIs is complex
Many social responses to HIV increase stigma
Fear of stigma is problematic because many:
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Dissociate themselves from risk groups
Avoid testing & counseling
Avoid accessing health care
Resist behaviour change
Scope of the Problem
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Incidence of HIV/AIDS will continue to
increase without appropriate interventions
Current public health response is inadequate
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Need to address stigma
Need to provide affordable drugs by implementing the
WHO ‘3 by 5 plan’
Need concentrated social action to normalize
prevention/care/treatment
Gender Roles & HIV
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Prevailing gender roles
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Considered by many to be the most
pervasive and universal problem associated
with HIV prevention
One of the few ethnographic
commonalities between women as a group
Globally, may present the largest
obstacle to HIV prevention
Social & Sexual Equity
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Integral to HIV/AIDS prevention
It is important to change
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Accepted patterns of male behaviour
Expected patterns of female behaviour
Then, women can be in a position to
protect themselves from the very real
threat of HIV infection -- which leads
ultimately, to death
Coming to Grips With the
Challenges
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Successful programs must:
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Improve and provide health information, care and
other services
Be culturally appropriate and gender-sensitive
Develop sex-specific, gender-balanced information
about HIV/AIDS and other STIs
Address different audiences in different settings
A New Challenge
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Multi- Drug Resistant HIV
Defining Attributes of Culture
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Culture includes ideas & beliefs that shape &
interpret any behaviour
Culture is different from society
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Culture = the meaning of behaviour
Society = the patterns of behaviour
Patterns of behaviour can be observed, but
the meaning is not apparent
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Although meaning can be inferred, analyzed, or
derived from asking the participants to interpret
their behaviour
Crucial Distinction
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Behaviour (social aspect)
Beliefs, ideas, & knowledge (cultural aspect)
Not necessarily consistent with each other
For example:
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a couple may know (a cultural factor) that they
should use condoms
But they do not use a condom (a social factor)
In this case, knowledge does not translate to
behaviour.
Theories of Change
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Popular theoretical models for HIV/STI risk
reduction highlight importance of
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Motivating target audiences
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think & talk about own need for behaviour change
(Peterson & Di Clemente, 2000)
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Providing information, behavioural skills,
removal of perceived barriers
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integral to the maintenance of individual-level
behaviour change
But… w/o personal motivation to integrate
risk reduction strategies, little changes
Individual-level Models
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Health Belief Model
AIDS Risk Reduction Model
Social Cognitive Theory
Theory of Reasoned Action
Theory of Planned Behaviour
Information-Motivation-Behavioural Skills
Transtheoretical Model
Individual-level Models
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Individual-level theoretical models for HIV/STI
risk reduction highlight the importance of
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Accurate information
Motivation
Behavioural skills social norms which support safer
behaviours
BUT… individual-level theories offer little insight
into how to shift social norms to support safer
behaviour
Social-level Models of Change
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Diffusion Theory
Leadership Models
Social Movement Theory
Social-level Models of Change
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Social models can shape the norms, values, &
interests of at-risk social groups
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Necessary adjuncts to any large-scale intervention
Norms and referents have a strong influence on
individual intention to act
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HIV highlights issues that are social
Individual-level risk-reduction enhanced by
addressing group and subcultural norms
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Capitalizing on existing community and interpersonal
networks to improve public health delivery
Removing social barriers that hinder safer behaviours
Effective HIV & Pregnancy
Prevention Programming
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Focus on reducing one or more specific HRSB
Theory-based
Advocate avoiding sexual risk-taking
Provide accurate information
Attend to social pressures
Model sexual communication & negotiation skills
Use interactive teaching methods
Appropriately targeted: age, sexual & cultural exp
Adequate in length
Include and train teachers and peer leaders
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Kirby, 2001
Challenges and Barriers
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Community level barriers
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Social norms surrounding sexuality and drug use
Patient level barriers
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Does person perceive that s/he is at risk?
Can they integrate change?
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Motivations = pleasure seeking
Substance use
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Can impede intervention efforts two ways
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Associated with increased risk-taking behaviour
Associated w/ reduced ability to implement risk-reduction
Challenges and Barriers
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Mental illness
Alcohol and HIV risk behaviours
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Heavy alcohol use associated with
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General increases in risky sexual behaviour
Decreased condom use
Increased risk of relapse into risky sexual behaviour
Contextual substance use appears to have the
highest risk
Non-injecting drug use (e.g., Crack cocaine)
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Related to associated sexual behaviour
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Especially drug-related prostitution activities